The Waiting is the Hardest Part

on December 18, 2017

The Waiting is the Hardest Part

With the recent passing of Tom Petty, one of the rock and roll icons of my youth, I’ve been listening to his music nostalgically. Somewhat ironically, my daughter and I had just listened to this classic (The Waiting) when we pulled into the parking lot during a recent visit to one of her specialists. From beyond the grave, Petty seemed to know what lay in store for us.

The First Impression

Our appointment time was 10:40 a.m. and we arrived around 10:20. As soon as we walked in, I knew we were in for an unpleasant experience. The waiting room, which was jam packed with chairs, was filled almost to capacity. We managed to find two empty seats, and I walked up to the desk to check in.

The receptionist handed me some forms to review and took my insurance card, then collected a co-payment from me, even though we had not been seen yet. There was no pleasant greeting, no acknowledgment of how busy the practice was this morning, no communication regarding our expected wait time, and certainly no apology.

Losing Trust

My daughter and I reviewed the forms and made the following observations:

  • There were no fewer than three mistakes (including her birthdate and an important element of her medical history). We had seen this specialist before, so the inaccuracies did not engender a sense of confidence in their record keeping or in the quality of medical advice we would receive.
  • The part of the form asking her to record her symptoms and the reason for the visit included just a series of boxes to be checked and a tiny amount of space to add explanatory comments. For whom is this supposed to be helpful? Given the inaccuracies just noted, what are the chances that any information we provide there is going to be correctly entered into the medical record?

I’ll revisit some of these issues in a future blog post, but what conclusions would you draw about this medical practice, given these two observations? Would your confidence in the quality of care you were about to receive increase or decrease?

Watching the Clock

But if those issues were annoying, they soon took a back seat to our frustration over the time we spent waiting. Needless to say, our appointment did not begin at 10:40. Or 10:50.  Or 11:00.

At 11:15, I returned to the desk to ask when we might be seen. The receptionist, clearly taken aback by this question, reacted as though this was a remarkable thing for a patient to ask. She had to re-confirm my daughter’s name and clarify which specialist we were supposed to see, then had to wait for one of the medical assistants to come to the desk. After a brief conference with the assistant, she told us it would likely be around noon. Still no apology or even acknowledgement of the delay.

I replied that we would not be able to wait that long. This was a Thursday; I had planned to take two hours out of my workday to attend this appointment with my daughter, but I had commitments of my own starting at 12:30. I explained that we would have to leave, and I asked for a refund of my co-payment. It should surprise no one at this point that I was told that was not possible, and that I would need to reschedule the appointment for a future date.

Aren’t They Ashamed?

The sensei reacted as though an invisible line had been crossed; as though he was deeply offended by this news. “You have one hundred waiting areas where patients wait an average of 45 minutes for a doctor?”

He paused and let the question hang in the air, then asked, “Aren’t you ashamed?”

The text above comes from the excellent book, Transforming Health Care, about Virginia Mason Medical Center in Seattle. As part of an ongoing journey, its leaders have been visiting Japan for more than 15 years to learn from management experts at places like Toyota. VM’s longstanding commitment to quality care and improving the patient experience has been well-documented in the literature. One of the things that sets Virginia Mason apart, in my opinion, is that their leaders were ashamed of those waiting areas. In too many other organizations, the response to a system that produces these kinds of frustrating delays is not shame, but indifference.

Waiting for Healthcare

In future blog posts, I’ll continue to address this issue, but I’d love to hear from others on this subject. What has been your experience with waiting for healthcare? Who’s addressing this issue effectively?  What do you think should be done differently?

Comments

  • Doug

    Queuing theory and Lean do seem lost on a majority of US healthcare providers. However, that’s not surprising in a system that has too many masters: government and private payers, regulators, all asking for data unrelated to true patient concerns (e.g. waiting). Resources go to other non-value added activities. Once a practice can remove itself from this system through direct care or capitated-payment schemes, it can really focus on serving patients.

    • David Willis

      It’s a great point Doug. I think your comments illustrate that there are really two problems here: the systemic causes of long waits (queues) in health care, AND the service orientation (or lack thereof) that fails to show any empathy to patients and their families who are subjected to those wait times.

      At the same time, there are providers who do a better job with this, and not all of them are in a capitated scheme.

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